Facilitators and barriers to modifying dietary and hygiene behaviours as adjuvant treatment in patients with depression in primary care: a qualitative study

Abstract

BackgroundMajor depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression.MethodsA qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data.ResultsBoth patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around ‘personal’, ‘programmatic’, and ‘transversal’ aspects. As for the personal aspects, categories regarding ‘patient history’, and ‘disposition’ were found; the programmatic aspects included categories such as ‘presentation and monitoring’, and modification of ‘cognitive’ and ‘behavioural’ habits; whereas the transversal aspects comprised the possibilities of ‘social support’ and defining categories of ‘objectives’.ConclusionThe implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions.

Effectiveness and cost-effectiveness of a lifestyle modification programme in the prevention and treatment of subclinical, mild and moderate depression in primary care: a randomised clinical trial protocol

“…77 In this case, the promotion of healthy lifestyles will be used to address depressive symptoms, as it has shown efficacy in a number of studies. [20][21][22][23][24][25][26][27][28][29][30][31] To ensure treatment adherence, facilitators should be used, such as the use of ICTs and the group format. They provide monitoring and social support, respectively.…”

“…Moreover, previous studies show that the use of facilitators is quite important (simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder and the provision of adequate feedback and social support) 23 to facilitate adherence to lifestyle modification programmes (LMPs). For example, enhanced motivation can be achieved through the use of information and communication technologies (ICTs) and with the social support resulting from intervention group participation.…”

Regulatory Flexibility of Sustaining Daily Routines and Mental Health in Adaptation to Financial Strain: A Vignette Approach

“…Although context sensitivity was inversely associated with positive affect at higher levels of perceived financial strain, in general, context sensitivity and responsiveness to feedback were linked with lower anxiety and depressive symptoms. Cultivating regular daily routines in everyday life may be a simple and effective intervention in reducing psychological distress [ 78 , 79 , 80 , 81 ], especially for persons with less socioeconomic resources (e.g., low savings, no home ownership) in times with multiple large-scale stressors such as civil unrest and pandemic [ 82 ].…”

Gut Health = Mental Health? The Impact of Diet and Dietary Supplements on Mood Disorders

“…For example, crosssectional data suggest that people with bipolar disorder consume unhealthier dietary patterns [7], and one case series found a connection between increased energy drink consumption and psychotic relapse in bipolar patients [8]. Similarly, changes in dietary patterns focusing on avoiding snacking and sugary foods and following a Mediterranean-style diet have been associated with improvements in depressive symptoms [9], overall mood disturbances including tension, anger, and confusion [10], anxiety [11], post-traumatic stress disorder symptoms [12], and binge eating behaviors [13]. In patients with a history of psychological trauma, patients who received dietary education based on the USDA Food Pyramid had improvement in post-traumatic stress disorder checklist symptoms over two years [12].…”